Supporting doctors, protecting patients GMCs Future Strategy SMEC - - PowerPoint PPT Presentation

“Supporting doctors, protecting patients” GMC’s Future Strategy

SMEC 2018

The GMC’s mission and responsibilities

To prevent harm and drive improvement in patient care by setting, upholding and raising standards for medical education and practice across the UK.

Our work in context – GMC in Scotland

BofAM

SAMD

Scottish Academy

• There are more GPs per head of population

in Scotland than any other country in the UK

• 52% of licensed doctors in Scotland are

female, compared to the UK average of 47%

• With 4,958 medical students Scotland has

the highest ratio of Medical Students to doctors (~1:4)

• Scotland has a higher reliance on UK-trained

doctors than the UK average, with a lower proportion of non-UK graduates (17%)

• Given many IMGs are also BME, the lower

proportion of BME doctors in Scotland (19%) is partly explained by this

• Rates of investigations ending in sanction
• r warning were almost the same across

the UK

Our work in context – medical profession in Scotland

Our work in context – systems under pressure

Four warning signs

• supply of new doctors has not kept pace with demand
• dependence on non-UK qualified doctors increased in some specialties
• at risk of becoming a less attractive place for overseas doctors to work
• strain on doctors training and being trained continues

Four priorities for the healthcare systems

• maintain a healthy supply of good doctors
• Help the medical profession evolve to meet the future needs of patients and healthcare
• reduce the pressure and burden on doctors wherever possible
• improve workplace culture; employment and training more supportive and flexible

The GMC’s changing approach to regulation

Complexity/Scope Time

Reactive In the castle Self Regulation Professional Dominance Ground hog day

• Anticipate & respond
• On the pitch
• Independent co-regulation
• Partnership with patients

& doctors

• Learning organisation
• Proactive but proportionate
• Range of regulatory tools/models
• Contextually sensitive
• Problem-centric
• Risk mitigation
• Upstream and supportive
• Focus informed by data/evidence
• Collective assurance

Challenge of limited awareness, relevance, limited resources/ infrastructure and damaged reputation Challenge of governance transformation, revalidation, FTP reform, MPTS, growth, understanding and sharing our data, demonstrating relevance, working with others, coming out of the castle Challenge of influencing patient safety through supporting doctors, partnerships, prevention and innovative risk-based regulatory strategies and soft power

Aim 1: Supporting doctors in maintaining good practice

Where we’ve come from

The majority of our focus, resource and expenditure on fitness to practise issues where harm to patients or doctors has already occurred.

Where we’re heading

Investing resources in supporting all doctors to maintain good

• practice. Early, supportive

interventions targeted to areas

• f greatest need.

Increased initiatives to support doctors in delivering good practice and prevent harm to patients. Implementation of revalidation to check that all doctors are up to date and fit to practise.

What we are already doing?

• In 2017 we held interactive guidance training sessions with 4,000 doctors and medical

students in Scotland

• Introducing a medical licensing assessment (MLA) by 2022, taking account of the feedback
• n our 2017 consultation proposals.
• Expanding our Welcome to UK Practice (WtUKP) Programme
• Embedding our Generic Professional Capabilities in training curricula
• Taking forward work on Credentialing and Flexible Training Pathways with partners across

the UK

• Undertaking a review of Health and Disability in medicine
• Using our data and partner insights to identify emerging concerns about training

environments and acting on those threats to doctors’ training and patient safety e.g. North Middlesex and East Kent

• Undertaking joint research with the Scottish Government on communication failures in

care to assist us in identifying opportunities to support doctors

• Commissioned an independent review of how we can best support the health and

wellbeing of the medical profession – led by Dame Denise Coia

Aim 1: Supporting doctors in maintaining good practice

By 2020 we expect…

Participation in our WtUKP Programme by doctors new to UK practice will have increased from 33% to 80%. Plans for the introduction of MLA and a linked assessment of professionalism will have been confirmed. We will have piloted an upstream regulatory intervention on three themes of identified harm using our research and data capabilities, such as doctor-patient communication failure.

Aim 1: Supporting doctors in maintaining good practice

Continued our work to embed Generic Professional Capabilities and support more flexibility in how doctors train and work

Where we’ve come from

Regulators pursuing

• bjectives independently,

with limited collaboration and information sharing. Improved information sharing and collaboration on a range of joint initiatives.

Where we’re heading

A more integrated form of regulation with a shared approach to identification and resolution of concerns and opportunities for

• improvement. Supporting local

cultures of professionalism, learning and openness

Aim 2: Strengthening collaboration with our regulatory partners across the health services

What we are doing already?

• We are working with HIS and NES through the National Information Sharing Group to improve

the use of our data for quality care in Scotland

• We’re working with Employers in Scotland – through the Scottish Government Management

Steering Group – to use our data to support workforce development

• We are continuing our work on the UK Medical Education Database (UKMED) with partners

including NES, UKFPO, MSC and Jon Dowell so that we can better understand entry into and progression through medical education and training

• We convene the UK Network of Medical Professionalism Teachers – supporting their work in

the teaching of professionalism in Medical Schools

• Preparing to review our approach to Education QA and Enhanced Monitoring
• We are working with partners to progress initial research to help characterise ‘failing

environments’ with a particular focus on PG Training environments

• We are co-producing guidance on Reflection and Reflective Practise with the BMA, the

Academy and other professional bodies – with a specific focus on Doctors in Training

Aim 2: Strengthening collaboration with our regulatory partners across the health services

By 2020 we expect…

Our stakeholder feedback surveys record improvements in perceptions of our collaborative working. We will have piloted a complaints handling approach based on the ‘local first’ principle. We will have consulted

• n a new approach to

Education Quality Assurance and piloted a protocol for how

• rganisations will work

together when training environments give rise to the most serious concerns. We will have piloted joint regulatory interventions for three themes of identified patient risk/harm.

Aim 2: Strengthening collaboration with our regulatory partners across the health services

Where we’ve come from

Pre-revalidation, the only contact we had with the profession was at registration and if doctors were referred into our fitness to practise processes. We have been speaking out

• ccasionally but not consistently.

The profession has recently questioned our independence and relevance.

Where we’re heading

Valued by the profession, and seen to speak out about challenges faced by doctors in meeting our standards and providing high quality care to

• patients. Trusted by the public

who have dealings with us.

Aim 3: Strengthening our relationship with the public and the profession

What are doing already?

• We work closely with the Scottish CMOs team to support the realisation of Realistic

Medicine and in particular are working with them now to review our guidance on Consent

• We have hosted 69 meetings with Patients and Carers in Scotland to support them to

understand our processes better when part of a GMC investigation.

• We engage with every medical school in the UK to support the teaching of

professionalism and help prepare students for being part of a regulated profession – our longstanding work with Scottish Medical Schools in this area has been used as good practise to inform our related programme in other parts of the UK

• We have developed a range of digital mobile apps which provide doctors with support
• n their CPD and how to apply our guidance in education, training and practise
• Extended our national surveys to Trainers and exploring the feasibility of similar surveys

for other profession cohorts including SAS doctors

• Updating guidance for the Recognition and approval of trainers

Aim 3: Strengthening our relationship with the public and the profession

By 2020 we expect…

We can demonstrate how engagement with the public and the profession has shaped our policies, content and campaigns. A strengthened perception of the fairness and effectiveness of our regulatory processes across all groups of doctors. Increased engagement with digital content and mobile apps that support good practice.

Aim 3: Strengthening our relationship with the public and the profession

Providing more guidance and support to help people to understand how to best get their concerns addressed and when to complain to the GMC or to another

• rganisation.

Published updated guidance on Consent and supported its adoption aligned with the principles of Realistic Medicine

Where we’ve come from

No presence in Northern Ireland, Scotland or Wales. Regulating wholly from England, with limited understanding of 4-country or regional needs and profiles. Regulatory approach applied consistently across all countries and systems but with limited targeting to local needs.

Where we’re heading

Applying consistent standards fairly, but flexing our operational approach across increasingly diversified systems. Data and evidence based regulation targeted to local needs and profiles.

Aim 4: Meeting the changing needs of the health services across the UK

What are we already doing?

• Working with the four UK Governments and others to ensure that our regulatory model

and data can support current and future workforce development needs – including credentialing, widening access agenda and graduate entry programmes here in Scotland

• Working with partners across the UK to understand the potential implications of Brexit
• n the medical workforce noting the different implications in each country linked to the

make up of the medical workforce

• Investing in our local presence and extending our National Advisory Fora to ensure our

work is informed by and relevant to the issues of workforce, quality and safety in each country

• Shaping our outreach teams that work with frontline doctors, healthcare providers and

systems regulators to align with local systems to support the delivery of our re-focussed approach to regulation

• Extending the range of our services in each of the four countries of the UK (for example,

WtUKP and meetings with patients and complainants)

Aim 4: Meeting the changing needs of the health services across the UK

By 2020 we expect…

The re-alignment of

• ur outreach teams to

best support the system structures and

• bjectives in each

country. To have created a suite of data packages relevant to each country’s needs. Increased provision of GMC services in the four countries. That feedback from the four countries demonstrates that our regulatory

• ffering is

appropriately tailored to meet their needs. To have undertaken a review of our registration framework to reflect any impact of Brexit

• n free

movement

Aim 4: Meeting the changing needs of the health services across the UK

GMC - Education and Training for excellence

Future strategy – Education and Training map

Supporting doctors in maintaining good practice

education interventions; quality assurance review; mental health and well-being; reflective practice

Reflective practice

• Senior doctors research
• Health and Wellbeing
• Disability review
• WTUKP
• MLA
• Credentialing
• Scope of practice
• Flexible training

Strengthening collaboration with regulatory partners

• UKMED
• QA And EM Review
• Reflective Practice
• Failing Environments
• Data to support education and

workforce planning

• Clinical Placement advice

Strengthening our relationship with the public and profession

• Consent review
• Reflective Practice
• CPD and GMP app

development

• MyGMP
• Surveys development
• Updating guidance on recognition of

trainers Meeting the changing needs of UK health services

• National and local data

and insight

• Guidance reviews – 4

country proofing

• Brexit analysis and insight
• Widening Access and GEPs
• New Medical Schools

Rebuilding trust: Our strategy and the Dr Bawa-Garba case

Future Strategy…..final reflections

• Supporting doctors to protect patients – QI

as well as QA

• Together, not alone - part of wider system
• f assurance
• Data and evidence based
• Moving “upstream” - proactive vs reactive
• Relevant, proportionate, transparent and

trusted for, not just in, each country of the UK …..

…..and with modern, 21st Century legislation….